Provider Demographics
NPI:1760874838
Name:WALKER, MICHAEL TROY
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TROY
Last Name:WALKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 HARTNELL ST
Mailing Address - Street 2:STE 300
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2887
Mailing Address - Country:US
Mailing Address - Phone:831-624-5311
Mailing Address - Fax:
Practice Address - Street 1:1320 E SHAW AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7919
Practice Address - Country:US
Practice Address - Phone:559-487-5660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW367781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical